Following up on the performance of the new AHCCCS Complete Care contract, we report on some of the challenges facing managed care organizations contracted with Arizona Medicaid and other news impacting our local market.
Members of The Hertel...Arizona News
A federal judge in Fort Worth, Texas ruled the Affordable Care Act (ACA) unconstitutional on Friday, leaving those enrolled in the ACA uncertain in terms of the law's future. No changes will be made to the 2010 act that is still law as appeals are being filed, the case does have the possibility of reaching the U.S. Supreme...Arizona News
As the enrollment period comes to an end for HealthCare.gov on Dec. 15, total Arizona enrollment for week five closed with 55,090 plan selections - down from 2017's week five enrollment toal of 67,266.
The 39 states using HealthCare.gov reported 773,250 plan selections in week five and a total of about 3.2 million sign ups nationally...National News
Providers, employers and consumer groups have unified to fight surprise billing and lobby Congress into passing legislation that would ultimately protect patients from receiving surprise medical bills from out-of-network providers.
These bills are most commonly issued to patients who may have visited an emergency department that does...National News
Efforts by Kansas and Louisiana, two Republican-led states, seeking to defund Medicaid funding for organizations offering women’s reproductive health services, such as abortions, was thwarted when the U.S. Supreme Court refused to hear the case in a 6 to 3 decision.
The two states attempted to block Medicaid funding for...Arizona News
UnitedHealth Group launched its concierge service, Navigate4Me just last year. The insurer already significantly expanded the services it offers to its Medicare Advantage enrollees.
The service started with just 12 navigators and has expanded to over 800 consisting of nurses and customer service advocates supporting 215,000...Arizona News
A new report by the Arizona Health Care Cost Containment System (AHCCCS) found that the number of Arizona Medicaid beneficiaries using emergency department services for non-emergencies has decreased over the past few years. From 2012 to 2017, the agency concluded that non-emergency coded visits decreased by 8.6 percent.
The coding...Arizona News
U.S. District Judge Roslyn Silver, the judge presiding over the Parsons v. Ryan settlement regarding the quality of inmate healthcare in Arizona prisons, appointed an expert on Thursday to examine if the state is complying with the changes ordered in the settlement agreement.
Non-compliance has been a perpetual problem in the...News
U.S. healthcare spending in 2017 increased 3.9 percent for a total of $3.5 trillion, according to the Centers for Medicare and Medicaid Services (CMS); the growth rate in 2016 was 4.8 percent.
Spending remained steady at about 18 percent of the nation's Gross Domestic Product (GDP), meaning health spending kept pace with the growth of...Arizona News
MDIG now has an agreement to provide sub-specialty diagnostic, vascular and interventional radiology services to three Steward hospitals in the state: Luke's Behavioral Health Center, St. Luke's Medical Center, and Mountain Vista Medical Center.
Effective December 1st, 2018MDIG will be the exclusive professional radiology services...News
Steward will reopen and rebrand the hospital in January 2019 purportedly to stave off Banner Health and Dignity Health's encroachment into the service area southeast of Phoenix.
In a presentation to the Florence Town Council last week, Steward announced its plans to brand the facility as a campus of its Mesa hospital.
The Florence...National News
The public squabble has lasted nearly a year, but now the two have agreed to extend their nationwide contract effective January 1, 2019.
UnitedHealthcare (UHC) has threatened for months to end its contract with Envision Healthcare. Envision fired the first shot this spring and missed its target when it was forced into arbitration...Arizona News
Two unnamed Medicaid managed care organizations (MCOs) in Arizona showed significant access control and configuration vulnerabilities in a Nov. 23 security review by the Office of Inspector General (OIG). Officials identified 19 different security flaws, suggesting other state MCOs could also be susceptible to risk.
The OIG...Arizona News
Arizona’s State House Health and Human Services Committee got an influx of new representatives and is still dominated by the GOP. The State Senate Health and Human Services Committee also released its 2019 roster with six new names.
Rep. Nancy Barto (R) will serve as the chair of the House committee and is a new member but no...Arizona News
Last week, the Centers for Medicare and Medicaid Services (CMS) released four State Empowerment and Relief waiver concepts for states to utilize under the Affordable Care Act’s (ACA) section 1332. CMS aims to encourage innovation and reduce burdens with the waivers, an action commended by Health and Human Services (HHS) secretary Alex...National News
The ink is barely dry on its $69 billion merger with Aetna and now CVS drops the news on its new Guaranteed Net Cost pricing model designed to simplify the financial arrangements underlying PBM contracts. CVS said it can deliver savings through PBM cost management strategies such as formulary, utilization management and performance...Arizona News
Insurance is evolving and Minneapolis-based Bright Health is a testament to the confidence shift toward technology-centered insurers. The healthcare startup just closed its largest funding round yet, totaling $200 million, a series C pool of capital that raised more money than expected.
Bright Health may be new in an industry...Arizona News
Mark Dewane will now chair the five-member board that oversees Maricopa Integrated Health System (MIHS), which includes Maricopa Medical Center, McDowell Healthcare Center, the Refugee Women’s Health Clinic, the Arizona Children’s Center, two behavioral health centers, and a dozen neighborhood Family Health Centers.
Megan Callahan, former chief strategy officer for McKesson was hired as Lyft's health lead as the company grows its healthcare business that focuses on aiding patients to get to their medical appointments on time.
There is buzz the company may go public in 2019 and Lyft may be looking to hike up revenues in the interim. CNBC...Arizona News
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to lower prescription drug costs for beneficiaries by making changes to Medicare Part D. The proposal could give insurers negotiating powers on drug prices by offering an expectation that plans would implement broader use of prior authorization (PA)...National News
One of the nation's pharmacy giants merges with one of the biggest health insurers with a vision of improving healthcare.
When announcing the deal on Wednesday, CVS Health President and CEO Larry Merlo said,
Today marks the start of a new day in health care and a transformative moment for our company and our industry. By delivering...Arizona News
The new, revolutionary treatment is only available at 175 hospitals across the nation.
This week, The Wall Street Journal reported on the challenges stroke victims face when a comprehensive stroke center isn't in the neighborhood.
Quoting Ryan McTaggart, director of interventional neuroradiology at Rhode Island Hospital,
There is...Arizona News
Democrats took the House during midterm elections, leaving a divided Congress to take on legislation. Healthcare policies and ideas were big ticket items on the campaign trail and Democrats are eager to implement their plans.
According to a CNN's exit polling, 41 percent of respondents said healthcare was the most important issue...Arizona News
After years of litigation, settlements and agreements, a judge presiding over the legal settlement concerning the quality of inmate care in Arizona’s prisons has raised the possibility of throwing out the four-year agreement and resuming with litigations.
This follows the state’s continuous noncompliance with the mandates...Arizona News
The California Attorney Generals office gave Dignity Health and Catholic Health Initiatives (CHI) conditional approval to merge and create a non-profit health system--CommonSpirit Health. Last November the two hospitals signed an agreement to combine operations following a year of negotiations.
CommonSpirit Health will include...